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Physician attitudes toward cytotoxic chemotherapy use in patients with advanced prostate carcinoma
William K Oh1, Patrice Tully, Philip W Kantoff
1Lank Center for Genitourinary Oncology, Department of Adult Oncology, Dana-Farber/Harvard Cancer Center, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. william_oh@dfci.harvard.edu
Background:
Attitudes toward the use of chemotherapy in patients with prostate carcinoma have changed as new therapeutics have demonstrated efficacy. This is important as randomized trials using chemotherapy are proposed. The authors used a questionnaire to investigate the attitudes of physicians in the New England area who care for patients with advanced prostate carcinoma.
Methods:
A 15-question survey was developed and mailed in the year 2000. No monetary incentives were used to encourage return of surveys. Baseline demographic data were obtained, including type of practice and number of patients with prostate carcinoma seen. Urologists, radiation oncologists, and medical oncologists were asked whether they had recommended chemotherapy for patients with prostate carcinoma, what they perceived as the effectiveness of specific drugs, what concerns they had regarding chemotherapy, and the appropriateness of chemotherapy in three hypothetical patient scenarios.
Results:
Of 1068 surveys that were delivered to practicing physicians, 232 surveys (22%) were returned and evaluable. Forty-six percent of respondents were urologists, 41% were medical oncologists, and 10% were radiation oncologists. Eighty-seven percent of respondents had recommended cytotoxic chemotherapy to their patients. Four agents were rated as moderately effective to very effective by 41-60% of respondents who rated effectiveness: estramustine, mitoxantrone, paclitaxel, and docetaxel. In three hypothetical patient scenarios of hormone-refractory prostate carcinoma, only one patient was judged as an appropriate candidate for chemotherapy. In a multivariate analysis, female physicians and physicians with practices comprised of > 25% patients with hormone-refractory prostate carcinoma were more likely to recommend chemotherapy. Concerns regarding severe toxicity and lack of benefit were among the most influential on respondent decisions to use chemotherapy.
Conclusions:
Most physicians who cared for patients with prostate carcinoma had recommended chemotherapy for patients with hormone-refractory disease. There were differences between specialties regarding the likelihood of recommending chemotherapy and clinical judgment regarding which patients were appropriate candidates for chemotherapy.